Mediastinal Tumors - Causes, Types, Symptoms, and Treatment

Introduction

Mediastinum is part of the chest between the sternum, spinal cord, and lungs. It involves the heart, trachea, esophagus, thymus gland, and the large blood vessels coming or going from the heart, like the aorta. It is divided into anterior, middle, and posterior sections. These areas have atypical, abnormal masses development called mediastinal tumors. This article describes mediastinal tumors' causes, symptoms, types, diagnoses, and treatment.

What Are Mediastinal Tumors?

Mediastinal tumors are abnormally formed masses of cells. It can be cancerous or non-cancerous cells. Mediastinal tumors are unusual growth, particularly in the chest and between the lungs. The mediastinum is surrounded by the lungs, spine, and sternum (breastbone). Mediastinal tumors also involve thymomas, lymphomas, germ cell tumors, and cysts.

What Are the Causes of Mediastinal Tumors?

The causes of mediastinal tumors are:

• Abnormal Cell Growth: Most tumors are formed if the cells form abnormal and out-of-control growths. It means the cells start an atypical growth itself.

• Underlying Conditions: If there are any underlying causes, like inflammation or infections, that can also trigger the mediastinal tumors.

• Congenital Tumors: The tissues can atypically be formed at the time of birth. For example, germ cell tumors, pericardial tumors, and bronchogenic tumors are congenitally present.

What Are the Different Types of Tumors?

Mediastinal tumors are of different types. They are differentiated on the basis of location. As the mediastinum is divided into three parts, anterior, middle, and posterior, its associated mediastinal tumors are divided into three sections.

Anterior Mediastinal Tumors:

• Thymomas: It is one of the commonest tumors mediastinal tumors. It originates from the thymus gland. It can be cancerous but can grow slowly.

• Thymic Carcinoma: It is also a common tumor but can be more aggressive than thymomas and even grows faster than thymomas.

• Thymic Cysts: These are non-cancerous or benign cysts. These usually create pressure on the adjacent structures and cause a few symptoms.

• Lymphoma: They can be a malignant form of tumor. Both can be Hodgkin or non-Hodgkin lymphoma.

• Germ Cell Tumors: These are benign tumors placed in the mediastinum, which is the common site for germ cells.

• Thyroid Masses: These are benign tumors originating from the thyroid gland and form abnormal masses like goiter.

Middle Mediastinal Tumors:

• Bronchogenic Cysts: These are present in the mediastinum's middle parts but are filled with mucus. These are small but benign cysts.

• Mediastinal Lymphadenopathy: It is present with swollen lymph nodes that have enlarged and are located in the middle mediastinal area.

• Pericardial Cyst: These cysts are present around the heart lining called the pericardium. They are benign cysts that are present around the heart.

• Tracheal Tumors: These are present over the trachea or windpipe. They can be malignant or benign tumors.

• Esophageal Tumors: They are associated with the esophagus or the food pipe. They can be both benign or malignant tumors.

• Other Conditions: These conditions involve achalasia (a disorder causing difficulty in passing food to the stomach from the esophagus), diverticulum (an out-pouch formed in the small intestine), hernia, aortic dissection, and aortic aneurysm.

Posterior Mediastinal Tumors:

• Neurogenic Tumors: These are benign tumors and are the most common posterior mediastinal tumors. These originate from nerve tissues and involve nerve sheath and ganglion to form nerve sheath tumors and ganglion cell tumors.

• Extramedullary Hematopoiesis: These are rare tumors.

• Neurenteric Cysts: There are also rare tumors of the mediastinum.

• Lymphadenopathy: As the middle also has lymph nodes, similar lymph nodes are also present in the posterior mediastinum. These lymph nodes also get enlarged and swollen.

• Conditions Associated Tumors: A few conditions affect the paravertebral areas that cause infections or malignant or benign masses.

What Are the Associated Symptoms of Mediastinal Tumors?

These mediastinal tumors are mostly left unnoticeable by the patients and get diagnosed during a chest X-ray. Usually, symptoms that are noticed by the mediastinal tumors are:

• Noisy breathing.

• Hoarseness.

• Cough.

• Wheezing.

• Shortness of breath.

• Hemoptysis (coughing blood)

• Fever.

• Chills,

• Chest pain.

• Weight loss.

• Drooping eyes.

• Tender lymph nodes.

How Are Mediastinal Tumors Diagnosed?

The mediastinal tumors are diagnosed by different means:

• Blood Test: The doctor usually takes the initial step of a blood test that defines the patient's enzymes and the tumor markers in the patient's body.

• Computed Tomography (CT) Scans: CT scan of the chest includes the mediastinal tumors that have affected the adjacent structures.

• Chest X-Rays: These chest X-rays include the masses of the tumors and depict the tumor's size and location.

• Positron Emission Tomography (PET) Scan: There are specific mediastinal tumors identified by the PET scan, such as lymphomas.

• Magnetic Resonance Imaging (MRI): The MRI can represent the spreading rate of the tumor, as how much pressure is placed on the adjacent structures.

• Biopsy: It is a type of sample from that particular area that reveals the tumor cells. The specific needles perform for biopsy. For example, a CT-guided needle biopsy is one such procedure.

• Mediastinoscopy: The procedure requires a biopsy of the mediastinum tissues by inserting a light tube in chests which are taken for the samples.

How Are Mediastinal Tumors Treated?

The treatment for mediastinal tumors is dependent upon their location and stage. However, surgical treatment is the best option. The treatment involves being:

• Surgery: Some cancerous tissues or tumors showing symptoms are made to go under surgery. For example, thymomas, thymic carcinomas, and neurogenic tumors all are gone for surgery. The surgery includes a sternotomy (cutting the breastbone or sternum).

• Radiation Therapy: It can be performed alone or after the surgical intervention, depending on the cancer type. Radiation therapy includes a high-energy X-ray beam, which is directed toward the tumor and leads to destruction.

• Chemotherapy: It includes the set of drugs that are required to kill the cancerous cells. It is performed to deplete the small centered tumors, such as thymic cancers.

• Antibiotics: These are provided to patients with an underlying infection along with the tumors. Or any lymphadenopathies (swelling of lymph nodes) that can lead to enlarged lymph nodes.

Conclusion:

Mediastinal tumors are the tumors of the chest that involve the mediastinum or the sternum (breastbone). The tumors are of three different types depending upon the location anterior, middle, or posterior mediastinal tumors. Some of the common mediastinal tumors are thymomas, thymic carcinomas, pericardial tumors, and neurogenic tumors. These symptoms are fever, chills, chest pain, shortness of breath, wheezing, hoarseness, noisy breathing, and enlarged lymph nodes. These tumors are ideally treated by surgical intervention or following radiation or chemotherapy instead.